Document Detail


Closure of atrial septal defects: is there still a place for surgery?
MedLine Citation:
PMID:  16315833     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. METHODS: Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type II and patent foramen ovale (group 3). RESULTS: Overall complications were minor and more frequent in group 1: 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery: 1 femoral arteriovenous fistula and 1 device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only 1 non-cardiac death and 1 re-operation for residual shunt in group 1, and 1 device removal for thrombosis in group 3. CONCLUSION: Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.
Authors:
Th Bov?; K Fran?ois; K De Groote; B Suys; D DeWolf; G Van Nooten
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta chirurgica Belgica     Volume:  105     ISSN:  0001-5458     ISO Abbreviation:  Acta Chir. Belg.     Publication Date:    2005 Sep-Oct
Date Detail:
Created Date:  2005-11-30     Completed Date:  2006-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370571     Medline TA:  Acta Chir Belg     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  497-503     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium. thierry.bove@ugent.be
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cardiac Surgical Procedures / methods*
Catheterization
Child
Child, Preschool
Female
Heart Septal Defects, Atrial / surgery*
Humans
Infant
Length of Stay
Male
Middle Aged
Morbidity
Postoperative Complications*
Prosthesis Implantation / methods*
Retrospective Studies
Sternum / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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